Last updated January 4, 2022

Laparoscopic Resection Of Curable Colon And Rectal Cancer

Recommendations

Tumor localization

When approaching colon resection laparoscopically, every effort should be made to localize the tumor preoperatively. Small lesions should be marked endoscopically with permanent tattoos before surgery to maximize the surgeon’s ability to identify the lesion. Surgeons should be prepared to use colonoscopy intraoperatively if lesion localization is uncertain. (Low, Strong)
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Diagnostic evaluation for metastases

We recommend that for patients with colon or rectal cancer, the chest, abdomen, and pelvis be evaluated preoperatively with CT scan. In patients with rectal cancer, we also recommend preoperative locoregional staging with endorectal ultrasound or MRI. (Low, Strong)
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Preparation for operation

We suggest that preoperative mechanical bowel preparation be used to facilitate manipulation of the bowel during the laparoscopic approach and to facilitate intraoperative colonoscopy when needed. (Low, Weak)
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Surgical Technique – Colon

We recommend that laparoscopic resection follow standard oncologic principles: proximal ligation of the primary arterial supply to the segment harboring the cancer, appropriate proximal and distal margins, and adequate lymphadenectomy. (High, Strong)
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Surgical Technique – Rectum

We recommend that laparoscopic resection for rectal cancer follow standard oncologic principles: Adequate distal margin, ligation at the origin of the arterial supply for the involved rectal segment, and mesorectal excision. (Moderate, Strong)
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Contiguous Organ Attachment

For locally advanced adherent colon and rectal tumors, an en bloc resection is recommended. We suggest an open approach if a laparoscopic en bloc resection cannot be performed adequately. (Low, Weak)
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Obstructing Colon Cancer (Right-sided)

We recommend that patients with an obstructing right or transverse colon cancer undergo a right or extended right colectomy. The open approach is required if the laparoscopic approach will not result in an oncologically sound resection. (Low, Strong)
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Obstructing Colon Cancer (Left-sided)

We suggest that for patients with an obstructing left-sided colon cancer, the procedure be individualized according to clinical factors. Colonic stenting may increase the likelihood of completing a one-stage procedure and may decrease the likelihood of an end colostomy. (Moderate, Weak)
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Prevention of Wound Complications

The use of a wound protector at the extraction site and the irrigation of port sites and extraction site incisions may reduce abdominal wall cancer recurrences. (Low, Strong)
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Robotic Surgery

While robotic surgery for colon and rectal cancer appears feasible and safe, in the absence of long-term oncologic outcome studies, no clear recommendation can be made. (Low, Weak)
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Training and Experience

Before surgeons apply the laparoscopic approach for the resection of curable colon and rectal cancer, they must have adequate knowledge, training, and experience in laparoscopic techniques and oncologic principles. (Moderate, Strong)
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Recommendation Grading

Overview

Title

Laparoscopic Resection Of Curable Colon And Rectal Cancer

Authoring Organization

Publication Month/Year

February 1, 2012

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

The following recommendations regarding the safe performance of laparoscopic resection for curable colon and rectal cancer are intended for surgeons experienced in both minimally invasive surgery and the surgical treatment of patients with colon and rectal cancer.

Target Patient Population

Patients with colon and rectal cancer

Inclusion Criteria

Female, Male, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory, Hospital, Operating and recovery room, Outpatient

Scope

Management, Treatment

Diseases/Conditions (MeSH)

D003107 - Colorectal Surgery, D012004 - Rectal Neoplasms, D003110 - Colonic Neoplasms, D010535 - Laparoscopy

Keywords

colon cancer, colorectal cancer, Colorectal Surgery, colorectal neoplasm

Source Citation

https://www.sages.org/publications/guidelines/guidelines-for-laparoscopic-resection-of-curable-colon-and-rectal-cancer/